{
  "abstract": "Introduction/Purpose Cangrelor is an intravenous antiplatelet agent with a rapid onset and short half-life that was initially used in cardiac interventions. Use of cangrelor has been extrapolated from the cardiac experience and has been increasingly used in neuroendovascular procedures, as well. Given the inherently higher risk of intracranial hemorrhage, lower doses are often used. We propose an ultra-low dose protocol, lower than previously reported in the literature, titrated using serial PRU (Plavix VerifyNow Assay) monitoring, based on experience at our institution.Materials and Methods A retrospective review of consecutive adult patients who received cangrelor intraoperatively for neurointervention was performed from March 2022 to April 2025. Electronic medical records were reviewed for patient demographic and clinical information, details of cangrelor use (including indication, dosing, and transition to oral antiplatelet agent), and postoperative outcomes.Results 54 adult patients (n=32 men, n=22 women) received cangrelor intraoperatively. The most common indications were acute ischemic stroke (n=39) and ruptured cerebral aneurysm (n=13). 46 patients (85.2%) underwent intracranial or extracranial stent placement during the index procedure. Our use of cangrelor evolved during this time, with increasingly lower doses used effectively (as low as 0.2 mcg/kg/minute initial infusion), and with eventual elimination of the standard bolus (n=19). The overall complication rate was low, with thromboembolic events occurring in only 2/54 patients (3.7%) and intracranial hemorrhage in 3/54 patients (5.6%; 2 symptomatic, 1 asymptomatic). Of the 19 patients who did not receive a bolus, there was only 1 thromboembolic complication and no new intracranial hemorrhage.Conclusion Given its rapid onset, short half-life, and IV administration, cangrelor is safe and effective in urgent/emergent neuroendovascular procedures where dual antiplatelet therapy (DAPT) is required. This institutional ultra-low dose and no-bolus protocol was effective at preventing thromboembolic complications, while mitigating the hemorrhage risk of DAPT in the delicate neurosurgical population.Disclosures K. Bowman: None. T. Staniszewski: None. J. McGrath: None. L. Stone McGuire: None. B. Aagaard-Kienitz: None. D. Niemann: None.Abstract E-338 Figure 1Abstract E-338 Table 1Cangrelor dosing informationVariableAverage (SD) or N (%)Bolus Dose (mcg/kg)Average4 (4.2)Range0-15No Bolus19 (35.2%)Initial Infusion (mcg/kg/min)Average0.74 (0.44)Range0.2-2.0First PRU116.2 (84.7)Average PRU107.4 (60.6)Abstract E-338 Table 2ComplicationsAverage (SD) or N (%)Thromboembolic2 (3.7%)Intracranial Hemorrhage3 (5.6%)GI Bleed2 (3.7%)Femoral Pseudoaneurysm3 (5.6%)Groin Hematoma3 (5.6%)",
  "authors": [
    {
      "affiliations": [
        "Neurological Surgery, University of Wisconsin, Madison, WI"
      ],
      "name": "K Bowman"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Wisconsin, Madison, WI"
      ],
      "name": "T Staniszewski"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Wisconsin, Madison, WI"
      ],
      "name": "J McGrath"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Wisconsin, Madison, WI"
      ],
      "name": "L Stone McGuire"
    },
    {
      "affiliations": [
        "Neurological Surgery and Radiology, University of Wisconsin, Madison, WI"
      ],
      "name": "B Aagaard-Kienitz"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Wisconsin, Madison, WI"
      ],
      "name": "D Niemann"
    },
    {
      "affiliations": [
        "Neurological Surgery, University of Wisconsin, Madison, WI"
      ],
      "name": "A Ahmed"
    }
  ],
  "title": "E-338 Safety and efficacy of ultra-low dose cangrelor in neurointerventional procedures: a single center retrospective study",
  "uid": "a037c5b1-ebf7-5d96-92dc-0bed35dc6507"
}